Mediterranean Diet Reduces Atherosclerosis Progression in Coronary Heart Disease: An Analysis of the CORDIOPREV Randomized Controlled Trial

Abstract

Background and Purpose: Lifestyle and diet affect cardiovascular risk, although there is currently no consensus about the best dietary model for the secondary prevention of cardiovascular disease. The CORDIOPREV study (Coronary Diet Intervention With Olive Oil and Cardiovascular Prevention) is an ongoing prospective, randomized, single-blind, controlled trial in 1002 coronary heart disease patients, whose primary objective is to compare the effect of 2 healthy dietary patterns (low-fat rich in complex carbohydrates versus Mediterranean diet rich in extra virgin olive oil) on the incidence of cardiovascular events. Here, we report the results of one secondary outcome of the CORDIOPREV study. Thus, to evaluate the efficacy of these diets in reducing cardiovascular disease risk. Intima-media thickness of both common carotid arteries (IMT-CC) was ultrasonically assessed bilaterally. IMT-CC is a validated surrogate for the status and future cardiovascular disease risk. Methods: From the total participants, 939 completed IMT-CC evaluation at baseline and were randomized to follow a Mediterranean diet (35% fat, 22% monounsaturated fatty acids, <50% carbohydrates) or a low-fat diet (28% fat, 12% monounsaturated fatty acids, >55% carbohydrates) with IMT-CC measurements at 5 and 7 years. We also analyzed the carotid plaque number and height. Results: The Mediterranean diet decreased IMT-CC at 5 years (−0.027±0.008 mm; P <0.001), maintained at 7 years (−0.031±0.008 mm; P <0.001), compared to baseline. The low-fat diet did not modify IMT-CC. IMT-CC and carotid plaque max height were higher decreased after the Mediterranean diet, compared to the low-fat diet, throughout follow-up. Baseline IMT-CC had the strongest association with the changes in IMT-CC after the dietary intervention. Conclusions: Long-term consumption of a Mediterranean diet rich in extravirgin olive oil, if compared to a low-fat diet, was associated with decreased atherosclerosis progression, as shown by reduced IMT-CC and carotid plaque height. These findings reinforce the clinical benefits of the Mediterranean diet in the context of secondary cardiovascular prevention. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT00924937.

Healthy lifestyle changes favourably affect common carotid intima-media thickness: the Healthy Lifestyle Community Programme (cohort 2)

“…In the present study, Aldana et al observed no effect of a 1-year intervention including a very low-fat plant-based diet (Ornish Program) on ccIMT in patients with clinically confirmed coronary artery disease (compared to usual care) (25) . In contrast to our study, healthful plant-based high-fat foods (such as nuts, extra virgin olive oil or cold-pressed rapeseed oil) were not recommended in the Ornish Program (25) , whereas more recent evidence suggests that these foods may not just improve cardiovascular health in general (29) but may also beneficially affect ccIMT (20,21) . In terms of diet-only interventions, five controlled trials have assessed the effect of moving towards a more plant-based diet on ccIMT: four of these studies used a Mediterranean diet (in Spain (20,21,30) and Italy (23) ), and one study used a Mediterranean-like diet (in Norway (31,32) ).…”

“…In contrast to our study, healthful plant-based high-fat foods (such as nuts, extra virgin olive oil or cold-pressed rapeseed oil) were not recommended in the Ornish Program (25) , whereas more recent evidence suggests that these foods may not just improve cardiovascular health in general (29) but may also beneficially affect ccIMT (20,21) . In terms of diet-only interventions, five controlled trials have assessed the effect of moving towards a more plant-based diet on ccIMT: four of these studies used a Mediterranean diet (in Spain (20,21,30) and Italy (23) ), and one study used a Mediterranean-like diet (in Norway (31,32) ). All of these studies were conducted with participants at higher CVD risk, with four out of these five studies showing a significant favourable effect on ccIMT (20,21,23,31,32) .…”

Description of a Cohort of Type 1 Diabetes Patients: Analysis of Comorbidities, Prevalence of Complications and Risk of Hypoglycemia

“…Our population, compared to others (especially European and North American ones), has different dietary habits. The Mediterranean diet, rich in olive oil, has been shown to reduce cardiovascular risk, as the PREDIMED study [17], as well as other studies [18,19,37] demonstrate. If we compare our results with those of the DCCT/EDIC group, which had a better overall control in terms of HbA1c (7.2% in the DCCT/EDIC group versus 7.7% in ours), our cohort shows better results from the cardiovascular point of view, despite a slightly worse control.…”

“…Only large database studies, including patients over several decades such as the Finnish cohort study by Harjustsalo and colleagues [16], provide a greater number of patients, with the biases of prolonged follow-up over time. In addition, our population is located in an area-the Mediterranean-different from the Nordic-European area (which is where most patients from the studies with the largest number of participants come from) in terms of customs and diet, and with a different prevalence of cardiovascular disease, probably associated with the Mediterranean diet [17][18][19].…”

Unusual Bioactive Compounds with Antioxidant Properties in Adjuvant Therapy Supporting Cognition Impairment in Age-Related Neurodegenerative Disorders

“…The high content of compounds with antioxidant and anti-inflammatory properties seems to be crucial in the effectiveness of MD in cognitive disorders. MD has a well-documented pro-health potential in cardiovascular disorders [176][177][178], improving cerebral blood supply and oxygenation. An essential assumption of MD is the regular intake of fish, rich in PUFAs, and olive oil, which are a source of monounsaturated fatty acids (MUFA), as well as moderate alcohol consumption, which plays an essential role in the prevention of age-related cognitive impairment and dementia [175].…”